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Brains Exam 4 > Week 1 > Flashcards

Week 1 Flashcards

1
Q

A clinical manifestation of an abnormal and excessive excitation and synchronization of a population of cortical neurons?

A

Seizure

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2
Q

A tendency toward recurrent seizures unprovoked by any systemic or acute neurologic insults?

A

Epilepsy

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3
Q

Sequence of events that converts normal neuronal network into a hyperexcitable network?

A

Epileptogensis

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4
Q

What location in the brain produces a large amount of burst firing?

A

Hippocampus

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5
Q

Where do recurrent excitatory pathways run and what do they run through?

A

1) Hippocampus and the neocortex

2) Through the Pyramidal Collateralls

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6
Q

What is hippocampal sclerosis common in?

A

Temporal lobe epilepsy

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7
Q

High frequency reptitive firing leading to an increase in presynaptic Ca2+ leads to what?

A

1) Facillitation- Increased glutamate release

2) Potentiation-Enhanced synaptic activity

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8
Q

Focal vs. General Seizures?

A

1) Focal- Conceptualized as orignating at some point within networks limited to one hemisphere.
2) Generalized seizures are conceptualized as originating at some point within and rapidly engaging bilaterally distributed networks.

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9
Q

What are some examples of structural metabolic causes?

A

Malformations of cortical development, neurocutanteous syndromes (tuberous sclerosis complex), tumor, infxion, trauma, angioma, stroke, etc…

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10
Q

If a baby (typically 5-6 months) comes in with flexion or extension spasms, occurring in clusters, and a hypsarrhytmia pattern on EEG. What should you be lead to diagnose?

A

West Syndrome

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11
Q

Describe an atonic seizure:

And list TX.

A

No warning, abrupt onset. Injuries common while being difficulty to treat.
TX: VAGAL NERVE STIMULATION and CORPUS CALLOSOTOMY MAY PREVENT FALLS

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12
Q

If a child comes in with MULTIPLE SEIZURE TYPES (atypical absence, generalized convulsive, atonic, myoclonic, partial), Mental retardation, and SLOW SPIKE AND WAVE (2 hertz) what should you be pointed to?

A

LENNOX-GASTAUT SYNDROME

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13
Q

Pt. Comes in with hourly episodes of sudden fear or panic could be an indication of what?

A

FOCAL SEIZURE (Parietal-think sensory)(simple partial)

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14
Q

Pt. maintaining consciousness, presents with extension of right arm when turning to the left, followed by agitated movements and vocalization with an abrupt recovery. Points towards what?

A

Focal seizure (FRONTAL-think motor)(Simple partial)

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15
Q

Patient with intractable seizures with episodes of confusion and disorientation, ASH LEAF spots on lamp exam, intractable seizures despite numerous AED’s:

A

Tuberous Sclerosis with Temporal Focal Seizures

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16
Q

Common symptoms of a focal seizure with impairment of consciouness (COMPLEX PARTIAL)

A

1) Aura is COMMON
2) Alteration of conciousness
3) Automatisms
4) Postictal confusion

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17
Q

Pt. with SMALL JERKS of arm movement early in the morning is suggestive of what? (in adolescence)

A

JME (juevinile myoclonic epilepsy)

  • Autosomal dominant inheritance
  • May develop generalized conculsive or absence seizures
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18
Q

What are the benign epilepsies of child hood?

A

1) BECTS benign epilepsy with centrotemporal spikes
2) Panayiotopoulos syndrome (beOCCIPTAL SPKES)
- NOCTURNAL SEIZURES ARE COMMON
- Remit by 15-16 years of age or older

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19
Q

Brief unresponsivness, eye flutter, suddent arrest of activity, 3 HERTZ SPKE AND WAVE are all indications of?

A

Absence

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20
Q

What is bladder incontinence with a generalized spike an wave EEG common with?

A

Generalized Tonic-Clonic (and other generalized convulsive types)

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21
Q

What do you prescribe to help with severe alcohol withdrawal?

A

Benzodiazepines

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22
Q

What should be prescribed in the elderly with alcohol withdrawal?

A

Think hepatoxicity and LOT because of their short half lives

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23
Q

What are the general side effects of sodium channel stabilizer anti-epileptic drugs?

A

1)Double vision/Nystagmus
-High frequency firing in medial longitudinal fasiculus for lateral gaze
-Nystagmus may show the patient is taking the drug appropriately but won’t tolerate an increase in dose
2)Ataxia/Vertigo
-Blocks integration of vestibular inputs and propioception
3)Sleepiness, lethargy, cognitive slowing
-Slowing of cortical neuron firing
DOSE DEPENDANT AND REVERSIBLE

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24
Q

Name the sodium channel AEDs?

A

Phenytoin, carbamazepine, valproic acid, phenobarbital, lamotrigine, topiramate
-People Can Vouch Pancakes (for a) Lovers Touch

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25
Q

Whats the MOA for Phenytoin? Interesting facts about metabolism? Idiosyncratic?

A

1) Sodium Stab.
2) First order until saturated then zero order (small increase can result in high drug levels)
3) Fibroblast stimulation (GINGIVITIS!!!!!!!!! and OSTEOPENIA (LOW VITAMIN D)) and Teratogenic (fetal hydantion syndrome)

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26
Q

MOA for Carbazepine? Uses? ADFX?

A

1) Sodium Stab.
2) Focal, GTC, Neuro Pathic Pain
3) Low white blood cells neutropenia, APLASTIC ANEMIA, RASH, HYPONATREMIA (low sodium)

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27
Q

What sodium stabilizer (AED) autoinduces P450 and creates an epoxide metabolite?

A

Carbamazepine (INTRODUCE SLOWLY)

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28
Q

MOA of Valproic Acid? Uses? Farm K?

A

1) Sodium Stab, ALSO BLOCKS T-Type Ca 2+, affects GABA inhibition
2) Focal, General, GENERALIZED EPILEPSIES (absence, juvenile myoclonic epil., good choice if you can’t tell whether the pt. focal or gen. seizure)
3) 90% Protein bound (displaces phenytoin), GLUCORNIDATED in liver

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29
Q

Which sodium stab. (AED) is known to cause weight gain, tremor, hair loss, jaundice, and pancreatitis?

A

Valproic Acid

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30
Q

MOA of Lamotrigine? Uses? Farm K?

A

1) Sodium Stab.
2) Foc., GTC, Generalized epilepsies
3) Slowed by Valproic acid

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31
Q

Which sodium stab. (AED) is most associated with rashes that potentially lead to SJS? How is this presented?

A

1) Lamotrigine

2) VERY SLOW TITRATION required when on Valproic Acid

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32
Q

MOA of Topiramate? Farm K?

A

1) Sodium stab, ENHANCES GABAa, CARBONIC ANYHDRYASE INHIB.

2) Mainly renal excretion

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33
Q

Which sodium stab (AED) is most associated with confusion/psychosis, paresthesias (tingling to _____ inhibition), and renal stones?

A

1) topiramate

- Blank=Carbonic Anhydrase Inhibition

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34
Q

Calcium channel alpha2delta subunit is the binding site for what? (Binding prevents what?)

A

GABApentin (and pregablin)

Binding prevents excessive synaptic glutamate release

35
Q

Synaptic Vesicle protein SV2A is the binding site for what? (Actions?)

A

Binding site for Levetiracetam (keppra) and its binding prevents EXCESSIVE glutamate release.

36
Q

MOA of Gabapentin? Uses? ADFX?

A

1) Binds Alpha2Delta Ca channel and prevents Glutamate release
2)Focal, GTC, Headache, neuropathic pain
3) Sedation, ataxia, weight gain, peripheral edema, WELL TOLERATED.
Side note MAINLY EXCRETED VIA RENAL SYSTEM.

37
Q

MOA of Levatiracetam? ADFX? Uses?

A

1) Binds SV2A synaptic vesicle protein (downregs glut.)
2) Somnolence, ataxia, weakness
3) Excreted via URINE

38
Q

____ is a non competitive AMPA glutamate receptor antagonist.

A

Perampanel (Fycompa)

39
Q

Which AED is associated with a serious risk of NEUROPSYCHIATRIC EVENTS such as violent thoughts or threatening behavior such as homicidal ideation?

A

Perampanel (Fycompa)

40
Q

What are the presynaptic targets enhancing GABAergic inhibition?

A

1) Enhance GABA synth. via GAD
2) Inhibit GABA breakdown by blocking GABA transaminase
3) block GABA reuptake transporters

41
Q

Postsynaptic GABAergic inhibition?

A

Enhance GABAa function

42
Q

While its primary site of action is alpha2delta it also has a secondary site of action that promotes what?

A

Gabapentin and it enhances GABA synthesis

43
Q

What AED enhnances GABA inhibition by blocking GABA reuptake at the presynaptic terminal?

A

TIAGABINE

44
Q

What two AEDs are known to reduce GABA metabolism?

A

Valproic acid

Vigabatrin (suicide inhibiter of GABA transaminase, used cautiously because SE of CONSTRICTION OF VISUAL FIELDS)

45
Q

Phenobarbital is said to have a paradoxical affect in children as compared to adults pertaining to a certain side affect what is this?

A

COGNITIVE SLOWING IN ADULTS WHILE HYPERACTIVITY IN KIDS

46
Q

How does buproprion (zyban, wellbutrin) assist with the quitting of smoking?

A

Its a dopamine reuptake inhibitor and NICOTINE ANTAGONIST!

47
Q

How does varenicline (chantix) aid in the cessation of smoking?

A

Its a partial agonist at alpha2beta2 nicotine receptors

48
Q

Which smoking cessation drug can cause a risk for psych symptoms?

A

Varenicline

49
Q

What drugs are typically abused as DIVERTED drugs for anethesiologists?

A

Fentanyl, meperidine, hydrocodone

50
Q

What class of diverted drugs is most commonly associated with mortality?

A

OPOIDS

51
Q

What is the most abused drug amongst physicians?

A

Alcohol

52
Q

What are the three D’s to look out for when physician impairment is suspect?

A

1) Delusion- Ideas of grandiosity, invulnerability
2) Denial- Impaired physician sees no problem with behavior
3) Defiance- Resistant to help of any sort

53
Q

What can be a life/career saving technique when thouroughly planned for known physician impairment?

A

INTERVENTION

  • Needs to rehearsed, factual, nonjudgemental, caring, and compassionate
  • Irrefutable evidence must be presented “like dude you remember that time you were tripping during gyno exam and thought you were spelunking? I took a video of it and while hilarious it was extremely offensive and we’re all genuinely entertained and disappointed with you. Just sayin.”
54
Q

Intervention requires what plans (besides what the other card says)?

A
  • Treatment/travel arrangements as the physician will be taking a “spa vakay”
  • -DX mand TX must be done by an addictionologist, so that he actually has a purpose
  • Main Goal: trick physician into treatment (hint lure with a bag of meth)
55
Q

Physician Health Committe stipulations after seeking help?

A
  • After contract for monitoring
  • Random urine drug screens
  • Relapse protocol
  • Advocacy (as it is earned?)
56
Q

______ will serve as the patients advocate as long as he/she upholds the contract.

A

Physicians Health Committee (Drug vendor will probably aid as well as long as you score him a sweet deal on some opiates, more willing to lie for added benefits)

57
Q

What are the general elements of a successful Tx. of physician impairment?

A
  • Intervention
  • Tx. at app. center
  • Family Involvment
  • Mutual help groups
  • Random drug screens
  • PHC
  • Aftercare
58
Q

Role of university hospital medical staff health committee?

A
  • Protect pt. from impaired physicians

- Advocate for recovering Dr’s

59
Q

Fxns of a University Hospital Staff Health Committee? (UHMSHC)

A
  • Education
  • Provision (resource info)
  • Confidential Assessment
  • Confidential professional Dx Evaluation
60
Q

Confidential assistance and support to self reported cases of Dr. impairment/illness and the placement into helpful tx. programs with sufficient resources applies to what two functions of a UHSMHC?

A
  • Provision

- Facilitation

61
Q

Impaired emotional and social responding, social compartmentalization is assoc. w/ TBI to what region?

A

Orbitofrontal cortex

62
Q

Impairment of sustained complex attention, judgement, insight, and problem solving can suggest a TBI of what region?

A

Dorsolateral prefrontal cortex

63
Q

Prolonged neuronal depolarization, increased intracellular Na+ and Ca++, glutamate release, oxidative failure and ATP depletion, are products of _______.

A

Prolonged seizure activity

64
Q

What are some cellular physical features associated with prolonged seizure activity?

A

Cytoskeletal degen., microtubule dysfunction, protein aggregation, clustering of procaspases, impairment of neuronal viability

65
Q

What are the numeric goals of tx. of cerebral perfusion pressure?

A

-Keep ICP 70mmHg

66
Q

Tx. of increased ICP?

A
  • Sedation’n’pharmacologic paralysis
  • Intubation (slight hyperventilation)
  • Maintenance of BP
  • Osmotic diuretics MANNITOL!!!!!!!!!!!
  • Barbiturate coma to DECREASE CEREBRAL METABOLISM
67
Q

How does mannitol help with ICP?

A
  • Increases blood osmolality, resulting in enhanced flow of water from tissues, INCLUDING THE BRAIN.
  • Works as diuretic because mannitol is not reabsorbed in the renal tubule so it increases the osmolality of filtrate and INCREASING EXCRETION OF WATER and FLUID!!!!!!
68
Q

What would be the best choice for a pt. who has problems keeping up with medications in alcohol withdrawal?

A

NALTREXONE (once monthly injection)

69
Q

What is the opiod overdose/toxicity triad?

A

Miotic pupils, Respiratory depression, Abnormal Mental status

70
Q

What is the tx. of opioid intoxication?

A

Supportive Mgmt. of:

  • Airway
  • Breathing
  • Naloxone
  • Circulation
71
Q

______ is a pure opioid antagonist, reverses opioids CNS EFX, has an onset of action of 2 mins, and is availible intranasaly or through IM auto injection.

A

Naloxone

72
Q

Which opioid antagonist does NOT cross the BBB and has minimal efx. on analgesia but blocks GI effects (constipation)?

A

Methynaltrexone and Alvimopan

73
Q

Which opioid antagonist is known to have a long half life and decreases cravings for alcohol?

A

Naltrexone

74
Q

What two findings indicate alcohol-use disorder WITH physical dependance?

A

Tolerance and Withdrawal

75
Q

What disease is a result of thiamine deficiency because of alcoholism? What part of the brain does it destroy? What can precipitate this disease?

A

Wernicke Encephalopathy

  • Mamillary bodies and regions of thalamus
  • Can be precipitated by GLUCOSE (must give thiamine before glucose in ER setting!!!)
76
Q

Both Wernicke’s Encephalopathy and Korsakoff’s Psychosis have three distinct findings, what are they?

A

1) W:
- Nystagmus
2) WK
- Confabulation
- Confusion

77
Q

What is the usual cause of death in Alz. Disease?

A

Pneumonia

78
Q

Vagal nerve stimulation can provide aid specifically with what type of seizure? Whats the sides?

A

1) Atonic Seizures

2) May cause HOARSENESS, cardiac arrhytmia, cough, pain

79
Q

Which AED has an alternative use of trigeminal neuralgia?

A

Carbamazepine

80
Q

Which AED has alternative uses such as painful neuropathies, headaches, and chronic pain disorders? (Remember Dr. Archer suggested this be over the counter)

A

Gabapentin

81
Q

Which AED is also used for headache prophylaxis and mood stabilization in bipolar disorder?

A

Valproic Acid

82
Q

Which AED has alternative uses such as headache prophylaxis, and weight loss?

A

Topiramate

83
Q

Using erythromycin may cause what toxicity with an AED drug?

A

Phenytoin (this is because erythromycin inhibits CYP thus RAISING the AED AMOUNT)

84
Q

Which AED works by activating potassium channels? Whats its sides?

A

1) Ezogabine (used in focal and GTC)

2) drowsiness, dizziness, vertigo, slurred speech, URINARY RETENTION, VISION AND SKIN PROBLEMS (turns skin BLUE!)

Brains Exam 4 (4 decks)

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